Provider Demographics
NPI:1508891748
Name:GRANT, ROBERT MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARTIN
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 POST ST STE 420
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3466
Mailing Address - Country:US
Mailing Address - Phone:415-885-7755
Mailing Address - Fax:415-885-3852
Practice Address - Street 1:2330 POST ST STE 420
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3466
Practice Address - Country:US
Practice Address - Phone:415-885-7755
Practice Address - Fax:415-885-3852
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67576207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G675760Medicaid
F51133Medicare UPIN
CA00G675760Medicaid